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In March, when the World Health Organization declared the SARS-CoV-2 infection, subsequently dubbed Covid-19, a pandemic, I wrote a piece highlighting the urgent need to develop a proper diagnostic test. At the time, we didn’t understand the complexity of detecting a little-known virus that was nevertheless very similar to other, commonly found coronaviruses.
Now, many months later, things look different: many people have undergone testing and we understand what detecting amplified viral elements implies, as opposed to detecting the antibodies we generate in response to the virus, and we are happier with a pinprick blood test as opposed to having a cotton bud stuck up our nose that feels like its taking a swab of our brain. We already have PCR, serological — with variations such as rapid tests (RDT), enzyme tests (ELISA), neutralization tests (PRNT) and chemiluminescence immunoassays (CLIA) — and even breath tests, trained dogs or lasers, and we are beginning to understand that, no matter what a certain ignoramus claims, the tests are the key to managing a pandemic that will be with us for a long time, and which at best will evolve into endemic.
We soon understood that a PCR could detect even small amounts of the virus’ genetic material, meaning it could remain positive long after the infection had passed, as well as being able to be confused with similar viruses. Rapid antigen-based tests can detect the presence of viral proteins and return positive results when a person is more infectious, while antibody-based tests can detect the patient’s immune response and are therefore ineffective at detecting the virus during the early stages of infection. In short, different tests for different uses, and all of them submitted to the same usual law of technology: they need scale to be produced more cheaply, simply, efficiently and accurately.
The first key to understanding the COVID-19 pandemic is learning to live with it. Many of the measures we have been forced to adopt, such as teleworking, wearing a mask and practicing good hygiene, will remain critical for many years to come. But one of the fundamental ways we can recover a part of our quality of life will have to do, as I commented last March, with developing simpler, faster, more accurate and cheaper diagnostic tests.
The first tests we started using to detect infection were not only expensive, but also not very reliable and easily contaminated. The results of mass testing in countries such as Singapore or South Korea led other countries to try to follow the same strategy and test larger numbers of people, as well as to understand that the tests, in fact, only diagnosed the situation of a person at a given time and therefore it was necessary to design strategies that would allow frequent testing. Receiving the results of a test after two or three days is of little use because we may have become infected during the time it has taken us to receive those results.
Which is why a race is now underway involving organizations such as the Bill and Melinda Gates Foundation, Spain’s PharmaMar, Cepheid, Abbot, 3M, Oxford University and many others. The XPRIZE Foundation has offered a prize of $5 million to whoever can come up with a reliable test that provides results in minutes or at most, a few hours, and costing under $12: some 699 teams from 70 countries have registered for the competition.
The idea is to be able to find a reliable and fast method that is so simple it does not require a laboratory or specialized medical personnel, that can be done in any setting, including at home, and at a price that allows its use on a massive scale. Companies such as Amazon and some universities have already gone for this approach: my university sends me a daily message reminding me to use an app to warn if I have had any type of symptom (and if so, with an additional page detailing them); if I have come into contact with someone who is infected; or if I have been exposed to risk situations, and that allows me to request any one of a number of tests on campus, including one which provides results in a few minutes if I am about to give a class.
It won’t be long before technology will have come up with low-cost, easy-to-use and reliable test kits that we could use, for example, when friends or family visit our homes, when we attend an event, and that will give us a greater sense of normality and (for many of us) much-missed physical contact. Of course, this feeling of normality will be fleeting: when we go back out into the world, we will again expose ourselves to different contacts and risks, requiring yet another test, which together with our masks, will be part of our daily routine for a long time.
The sooner we get our heads round this and know what it is we expect from technology, the better we will handle the wait until these tests arrive. For the time being, be patient and stay safe…
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November 01, 2020 at 06:38PM
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Hang In There: Easy-To-Use, Low-Cost Covid Tests Are On The Way - Forbes
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